Stress Management in Hand Therapy Vanessa Zamora Ly, OTDS | Doctor of Occupational Therapy Program | Huntington University

Project Description

Hand trauma victims are susceptible to psychological distress because hands are essential to an individual's identity. Hands help individuals independently work, enjoy leisurely activities, perform self-care tasks, and interact and communicate with others. When occupational performance is impacted, individuals may feel insecure, incompetent, and dependent on others (Ladds et al., 2017). Feeling inadequate and dependent may affect an individual's roles, such as a spouse, friend, worker, caregiver, and other meaningful roles (Hannah, 2011). Cederlund et al. (2010) found that individuals were more protective of the injured hand by avoiding tasks and activities primarily from the fear of re-injury. Therefore, frustration and stress may increase due to income being jeopardized and the inability to perform tasks as before the injury (Hannah, 2011).

When individuals experience trauma or injuries to the upper extremities (UE), emotions and physical sensations may become imprinted during the experience. Trauma may rob individuals of feeling in charge of themselves. Traumatized individuals have trouble enjoying day-to-day life due to distinguishing whether they are safe or in danger. Having experience is required to restore a sense of physical safety. It is normal for individuals to be on guard; however, making emotional connections requires putting that guard down. (van der Kolk, 2014).

What has happened cannot be undone, but what can be dealt with are the emotional and physical sensations imprinted on the body, mind, and soul. Since the autonomic nervous system (ANS) causes the fight-or-flight response to activate, if stress does not subside, it may lead to exorbitant amounts of inflammation and excessive scarring (Bayat & Ud-Din, 2022). Although inflammation is expected in the wound healing process, too much may result in stiffness, reduction in strength, decreased range of motion (ROM), increased vulnerability to reinjury, chronic pain, and contractures (Chang et al., 2020; Le Cara, 2016). Thus, it may lead to a decrease in quality of life (QOL).

The challenge to recovery is reestablishing ownership in one's body and mind. This involves finding a way to become calm and focused and learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that may remind individuals of the past (van der Kolk, 2014). As individuals confront what happened to them and regain control over themselves, the sooner they may be able to return to the day-to-day life and meaningful activities of daily life (ADLs).

The capstone project aimed to educate and advocate to certified hand therapists (CHTs) on the impacts of stress on wound healing and to encourage using strategies to manage stress in hand therapy to improve the effectiveness of recovery and healing. A PowerPoint presentation and educational resource were created to educate CHTs on the benefits of implementing stress management into hand therapy and provide strategies that can be used to implement in treatment sessions.

Needs Assessment

Individuals with hand trauma are susceptible to psychological distress because hands are an essential part of identity (Ladds et al., 2017).

Psychological factors and other supports are often overlooked in hand therapy due to focusing on physical recovery (Chown et al., 2018).

According to Hardison et al. (2022), UE injuries require physical interventions in conjunction with psychosocial interventions to be most effective.

Pain is primarily one of the significant problems contributing to distress, suffering, and reduced quality of life (Matsuzaki & Upton, 2012).

Minimally reducing the severity of symptoms using multiple approaches to intervention significantly improves the QOL for individuals suffering from chronic pain, so early detection and intervention are crucial (Ladds et al., 2017).

Literature Review

Individuals using avoidance-based or denial coping strategies are negatively correlated with (a) QOL, (b) functions of the hand, (c) depression, and (d) other symptoms due to trauma (Hardison et al., 2022)

Not addressing nonadaptive thoughts may strengthen nonadaptive behaviors such as (a) avoidance, (b) disability, and (c) hypervigilance, as well as psychological distress such as (a) depression and (b) anxiety (Gouin & Kiecolt-Glaser, 2011).

Minimizing and gaining insight into anxiety-provoking factors that elevate or reduce anxiety and pain helps individuals acquire a sense of control rather than remaining helpless and hopeless to symptoms (Woo, 2012).

Mindfulness-based interventions (MBIs) support the rehabilitation process by (a) increasing engagement, (b) communication, (c) compassion, and (d) improving the acceptance of bodily sensations and emotions (Hardison et al., 2022).

Social support is a strategy used to decrease psychological distress, which is associated with better health outcomes (Gouin & Kiecolt-Glaser, 2011).

Project Outcomes

The capstone project included seven deliverables presented below.

DELIVERABLE #1: a PowerPoint presentation and educational resource.

DELIVERABLE #2: certificate of completion in stress management.

DELIVERABLE #3: analysis of the participant's knowledge of the benefits of implementing stress management in hand therapy.

DELIVERABLE #4: compilation of event flyers, correspondences, and solicitation scripts for the hand therapy event.

DELIVERABLE #5: designed survey tool aimed to capture participant knowledge.

DELIVERABLE #6: data collection analyzed in the form of an infographic.

DELIVERABLE #7: data collection methodology document outline plan.

Primary Area of Focus Education

• Conducted research on evidence-based practice articles and reliable websites on managing stress and the impacts of stress on recovery in hand therapy.
• Participated in a continuing education course to increase knowledge, credibility, and competence on the impacts of stress on recovery.
• Created a PowerPoint presentation to educate CHTs on the impacts of stress, the benefits of managing stress, and stress management strategies in hand therapy to optimize recovery outcomes.
• Presented the PowerPoint presentation to CHTs via Zoom and at the office of Hand Center of Nevada.
• Recorded the PowerPoint presentation to allow individuals to rewatch, share, or view it on their own time.

Secondary Area of Focus Advocacy

• Created a promotional flyer to increase attendance of CHTs for the PowerPoint presentation.
• Conducted research to find information on the impacts of stress and stress management strategies on evidence-based practice articles and reliable websites to present to CHTs to increase awareness and provide stress management strategies to help encourage the incorporation of the strategies in hand therapy.
• Created a free educational resource to assist CHTs in building knowledge and competence in managing the patient's stress and educating patients on the impacts of stress.
• Created two free posters for CHTs to educate patients indirectly and allow the patient to initiate the conversation about stress with their healthcare team by placing them in the lobby, on the walls, or on the tables.

Tertiary Area of Focus Research

• Interviewed CHTs via emails, phone calls, and through social media to assess their knowledge, interest, and concerns about implementing stress management and the impacts of stress on recovery in hand therapy.
• Created a survey to assess the need for stress management in hand therapy.
• Created a flyer and solicitation script to promote the survey by posting on Facebook groups related to hand therapy and occupational therapy, Occupational Therapy Instagram account, the American Occupational Therapy Association blog, and the American Society of Hand Therapists blog.
• Published survey on Facebook groups related to hand therapy and occupational therapy, Occupational Therapy Instagram account, the American Occupational Therapy Association blog, and the American Society of Hand Therapists blog to gain responses.
• Analyzed the data from 31 respondents.
• Created an Infographic based on the 31 respones from the survey.

Quaternary Area of Focus Clinical Practice

• Observed CHTs and occupational therapists treating patients to assess how they assist patients with managing their stress and worries.
• Observed what may cause patients to become stressed or anxious.
• Interviewed patients on the causes of their stress or anxiety and what helped relieve their stress or anxiety.
• Interviewed CHTs and occupational therapists on concerns about implementing stress management strategies in hand therapy, what strategies they currently use to manage stress for their patients, and what may cause their patients to feel stressed or anxious.
• Gained an understanding of the workflow and the environment of a hand therapy setting.
• Gained knowledge on treating patients in the hand therapy setting to identify the appropriate time to implement stress management strategies.

Reflection

The doctoral capstone experience was beneficial by building knowledge and expertise and gaining insight into passionate topics while growing professionally and personally by leading in developing, implementing, and disseminating the project.